Active NPI
Kevin Jennings, PAC
- Physician Assistant
- Pottsville, PA
National Provider Identifier
1407146889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA001406L
- Practice address
- 420 S Jackson St
Pottsville, PA 17901-3625 - Phone
- (570) 621-5000
- Fax
- (570) 621-5589
- NPI assigned
- Apr 19, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA001406L | PA | Primary |
Addresses
Primary practice location
420 S Jackson St
Pottsville, PA 17901-3625
Mailing address
420 S Jackson St
Pottsville, PA 17901-3625
Phone (570) 621-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MA001406L | Other | PA | PA LICENSE NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA001406L | PA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1303171200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303171200000",
"number": "1407146889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 S JACKSON ST",
"city": "POTTSVILLE",
"state": "PA",
"postal_code": "179013625",
"telephone_number": "570-621-5000",
"fax_number": "570-621-5589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 S JACKSON ST",
"city": "POTTSVILLE",
"state": "PA",
"postal_code": "179013625",
"telephone_number": "570-621-5000",
"fax_number": "570-621-5589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "KEVIN",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-04-19",
"last_updated": "2011-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA001406L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PA LICENSE NUMBER",
"identifier": "MA001406L",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pottsville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.